MEDICARE: ADA CHUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN22756	FL

General Provider Information

NPI Number	:	1801300942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA CHUNG

Provider Business Mailing Address
First Line	:	9406 ATLANTIC BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-8221
Country	:	US
Telephone Number	:	904-204-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	9406 ATLANTIC BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-8221
Country	:	US
Telephone Number	:	904-204-9105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	01/05/2026

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Directions to “ ADA CHUNG ” Practice Location

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